Classification - Directed Treatment of Low Back Pain

描述（由申请人提供）：大多数人在成年后会经历腰痛（LBP），超过50%的经历过腰痛的人会复发。尽管与控制这种疾病相关的医疗保健费用很高，但没有发现任何治疗方法能够始终有效地改善通常持续存在的症状和相关残疾，更重要的是，减少复发。有人认为，缺乏任何一种治疗方法的支持是对异质性LBP患者群体进行研究的结果，需要一种将LBP患者分类为更均匀的群体的系统。最近，一种基于运动系统相关损伤的LBP患者分类系统已经被描述和测试。用于腰痛分类的损伤与(1)临床检查和(2)功能活动期间与患者症状一致的特定运动方向和对齐有关。本提案的主要目的是开展一项前瞻性、随机、对照临床试验，以确定在改善慢性下腰痛患者的短期和长期预后方面，以患者的特异性损伤为基础的下腰痛分类指导治疗是否比非特异性物理治疗更有效。本研究的具体目的是确定分类特异性治疗与非特异性治疗在18个月期间对(1)损伤的影响，包括症状（强度、频率、持续时间、位置和复发），临床检查中的运动和对齐损伤，以及标准化临床测试中的运动和对齐损伤的运动学。(2)用Oswestry腰痛问卷和Baecke习惯性活动问卷测量功能限制，(3)用SF-36和腰痛相关活动限制日数测量残疾。分类特异性治疗将强调(1)改变患者在功能活动中对运动和对齐障碍的使用，(2)锻炼以减轻损伤，以及(3)教育以了解特定的运动和对齐方向如何导致症状。非特异性物理治疗包括一般躯干强化、躯干和四肢柔韧性、身体力学教育和功能活动指导。预后因素也将被检查。这项研究的发现对于下腰痛患者的康复检查和治疗方法的决策具有重要意义，下腰痛通常是一种持续性、复发性和昂贵的疾病。

DESCRIPTION (provided by applicant): Most people will experience low back pain (LBP) during their adult lives and more than 50% of the people who experience an episode of LBP will have a recurrence. Despite the high health care costs associated with managing this condition, no treatment has been found to be consistently effective in improving the often persistent symptoms and related disability, and more importantly, curtailing the recurrences. It has been suggested that the lack of support of any one treatment is the result of studies being conducted on heterogeneous groups of people with LBP, and a system for classifying people with LBP into more homogeneous groups is needed. Recently, a system of classifying people with LBP based on movement-system related impairments has been described and tested. The impairments used to classify LBP are related to the specific directions of movements and alignments consistently related to the person's symptoms during (1) a clinical examination, and (2) functional activities. The primary purpose of this proposal is to conduct a prospective, randomized, controlled clinical trial to determine if treatment directed by a person's specific impairment- based LBP classification is more effective than non-specific physical therapy care in improving short- and long-term outcomes in people with chronic LBP. The specific aims of this study are to determine the effect of classification- specific treatment versus non-specific treatment across an 18 month period on (1) impairments which include symptoms (intensity, frequency, duration, location, and recurrences), movement and alignment impairments on clinical examination tests, and kinematics of movement and alignment impairments with standardized clinical tests, (2) functional limitations measured with the Oswestry LBP questionnaire and the Baecke Habitual Activity questionnaire, and (3) disability measured with the SF-36 and number of LBP-related activity limitations days. Classification-specific treatment will emphasize (1) changing the person's use of movement and alignment impairments in functional activities, (2) exercise to alleviate impairments, and (3) education to understand how specific directions of movements and alignments contribute to symptoms. The non-specific physical therapy treatment will include general trunk strengthening, trunk and extremity flexibility, and education about body mechanics and guidelines for performance of functional activities. Prognostic factors also will be examined. The findings from this study have important implications with regard to decisions made about examination and treatment methods used in rehabilitation of people with LBP, an often persistent, recurrent and costly condition.